Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
PR Exam Init Preventive Phys New Visit During 1st 12 Mo of Mcare Enrollment
Low
$56
Average
$291
Median
$250
High
$599
Each hospital's average Premera rate, under the methodology and billing class chosen below.
47 hospitals; the 90th percentile is 3.3× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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82 hospital rates
iThe hospitals that file a Premera rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $223 | $223 | — | — | — | $223 – $223 |
| 2 | Central Community Hospital Elkader, IA professional · fee schedule · inpatient | 1 | $223 | $223 | — | — | — | $223 – $223 |
| 3 | Central Community Hospital Elkader, IA professional · fee schedule · outpatient | 1 | $242 | $242 | — | — | — | $242 – $242 |
| 4 | Central Washington Health Services Association Wenatchee, WA other · outpatient | 1 | $262 | $262 | — | — | — | $262 – $262 |
| 5 | Central Washington Health Services Association Wenatchee, WA percent of total billed charges · outpatientfrom % of charges | 3 | $154 | $150 | $6 | 4% | — | $140 – $154 |
| 6 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $251 | $266 | $81 | 30% | — | $183 – $380 |
| 7 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · both | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 8 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · outpatient | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 9 | Covenant Medical Center Inc Waterloo, IA professional · fee schedule · both | 1 | $223 | $223 | — | — | — | $223 – $223 |
| 10 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 4 | $488 | $453 | $139 | 31% | — | $226 – $607 |
| 11 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 12 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · outpatient | 1 | $763 | $763 | — | — | — | $763 – $763 |
| 13 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · both | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 14 | Holy Cross Hospital-Silver Spring Silver Spring, MD professional · percent of total billed charges · bothfrom % of charges | 1 | $277 | $277 | — | — | — | $277 – $277 |
| 15 | Mary Bridge Children's Hospital Tacoma, WA fee schedule · outpatient | 4 | $488 | $453 | $139 | 31% | — | $226 – $607 |
| 16 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · inpatient | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 17 | Mercy Fitzgerald Hospital Darby, PA professional · fee schedule · outpatient | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 18 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $62 | $62 | — | — | — | $62 – $62 |
| 19 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · inpatient | 1 | $265 | $265 | — | — | — | $265 – $265 |
| 20 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 1 | $207 | $207 | — | — | — | $207 – $207 |
| 21 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · inpatient | 1 | $265 | $265 | — | — | — | $265 – $265 |
| 22 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · outpatient | 1 | $265 | $265 | — | — | — | $265 – $265 |
| 23 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 24 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · both | 1 | $225 | $225 | — | — | — | $225 – $225 |
| 25 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · both | 1 | $136 | $136 | — | — | — | $136 – $136 |
← Payers reporting HCPCS G0402 · Snapshot 20261111T120946Z-9134e7f7